Bidirectional Propulsion of Devices Along the Gastrointestinal Tract Using Electrostimulation

This thesis describes a method for propelling devices such as video capsule endoscopes in either direction along the small intestines using electrostimulation-induced muscular contractions. When swallowed, passive diagnostic ‘one-shot’ devices rely on sporadic peristaltic movement, possibly missing vital ‘areas of interest’. This bidirectional propulsion method provides active control for that all-important ‘second look’. Design considerations, within the dimensional constraints, required a device shape that would achieve maximum propulsion from safely induced useful contractions produced by the electrodes and encapsulated miniature electrostimulator. Construction materials would have to produce minimal friction against the mucosal surface while having the physical properties to facilitate construction and electrode attachment. Design investigations included coefficient of friction measurements of different construction materials and the evaluation of different capsule and electrode dimensions over a range of stimulation parameters, to obtain optimal propulsion. A swallowable 11 mm diameter device was propelled at 121 mm/min with stimulation parameters of 12.5 Hz, 20 ms, at 20 V in an anaesthetised pig. A modified passive video capsule endoscope was propelled at 120 mm/min with stimulation parameters of 12.5 Hz, 20 ms, at 10 V in an unanaesthetised human volunteer. A radio-controlled capsule incorporating an electrostimulator, voltage converter and 3 V power supply was propelled at 60 mm/min with stimulation parameters of 12.5 Hz, 20 ms, and 30 V in an anaesthetised pig. 4 Other possible uses of electrostimulation were investigated including propulsion of anally administered large intestine devices and introduction of the intestinal mucosal surface into a biopsy chamber. Results are presented. The ultimate aim of the project was to provide bidirectional propulsion for wireless remote controlled devices along the gastrointestinal tract utilising contractile force produced by electrostimulation of the intestinal wall. The controllability of this system could provide clinicians with a real time view of the entire small intestines without surgical enteroscopy

Mechanisms for introducing large medical devices into developing countries. Avoiding the pitfalls of the past and providing possible solutions for the future

The predicted emergence of cancer as a major NCD in developing countries by 2020 has already prompted some governments to invest in cancer treatment. The large medical devices required to provide comprehensive radiotherapy are both expensive to purchase and to install. Manufacturers have therefore started producing a range of large medical devices which are specifically designed for the emerging market in developing countries. This market, however, can produce unforeseen problems. The lack of experience of the logistics involved in the delivery and installation of such large pieces of equipment can often lead to underestimations in time scales by the recipients. Advice and assistance on the clinical procurement process is essential for avoiding long delays. Within the UK, the lifecycle of radiotherapy machines can often be ten years or less, which in most cases is well below the actual lifetime of the machines. Therefore many machines are decommissioned to be scrapped well within the usable equipment lifetime. However, if decommissioning was performed so that the machine could be salvaged, the extra cost would be relatively low. Such machines could be serviced and donated to developing countries allowing them to increase their radiotherapy coverage greatly for the cost of the decommissioning, servicing and installation process. Therefore it would seem that with a small change to the decommissioning process of large medical devices, developing countries who could benefit from equipment, which otherwise would be scrapped, could attain a large number of life changing pieces of equipment within their tight budgetary constraints and make a real impact on the predicted increase in cancer deaths

Is the provision of medical equipment enough? Addressing the need for adequate training and support to maximise the effectiveness of introducing modern equipment into the developing world

The World Health Organization predicted that by 2017 the death toll due to cancer in developing countries will be greater than 10 million per year accounting for more than two thirds of the world cancer deaths, exceeding those caused by HIV/AIDS, tuberculosis and malaria combined. However, the developing world has very limited provision for cancer diagnosis and treatment. While radiotherapy continues to play a major role in the global fight against the disease, in developing countries this life saving procedure remains extremely inadequate. A large proportion of all cancer patients will require radiation treatment during the course of their disease. However, in these regions radiotherapy services are very limited and not available to many cancer patients. In a number of regions this issue is starting to be addressed but resources are limited and very few of the staff have had the opportunity to be trained in modern radiotherapy techniques. Consequently they face a difficult challenge to implement new technologies and get quickly up to speed on clinical protocols, equipment maintenance and operation, at the same time as running a busy cancer service. It would therefore seem that the application of resources and expertise that exists in the UK, to assist the healthcare professionals who are providing cancer treatment in the developing countries, would be of enormous benefit. The sole provision of modern medical equipment is not enough to rectify the considerable difference between the levels of healthcare available. Once the equipment is in place, there have to be enough trained personnel to deliver the required level of care. Therefore, the aim of the paRTner project is to instigate and develop a continuing voluntary partnership infrastructure of high quality training and support for radiotherapy professionals within these developing countries, while providing an essential supply chain of donated modern medical equipment